- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,311.31 / $5,128.61
| Facility | | $1,778.28 | $3,311.31 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,348.96 / $3,235.94
| Professional | | $1,096.48 | $1,348.96 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,897.79 / $45,708.82
| Facility | | $1,995.26 | $4,897.79 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,778.28 / $8,912.51
| Professional | | $1,071.52 | $1,778.28 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,819.70 / $3,388.44
| Professional | | $1,174.90 | $1,819.70 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,995.26 / $7,079.46
| Facility | | $954.99 | $1,995.26 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,584.89 / $2,187.76
| Professional | | $1,258.93 | $1,584.89 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,187.76 / $3,388.44
| Professional | | $1,148.15 | $2,187.76 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,897.79 / $45,708.82
| Facility | | $2,041.74 | $4,897.79 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,778.28 / $8,912.51
| Professional | | $1,071.52 | $1,778.28 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,981.07 / $9,120.11
| Facility | | $1,862.09 | $3,981.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,778.28 / $3,467.37
| Professional | | $1,174.90 | $1,778.28 | $3,467.37 |